HESI RN
Pediatric HESI
1. A 15-year-old client with type 1 diabetes presents to the clinic for a routine follow-up. The nurse notes that the client’s hemoglobin A1c is 10%. What should the nurse include in the plan of care?
- A. Increase the frequency of self-monitoring of blood glucose.
- B. Discuss dietary changes to reduce carbohydrate intake.
- C. Review the client’s insulin administration technique.
- D. All of the above
Correct answer: D
Rationale: A hemoglobin A1c of 10% indicates poor blood glucose control, reflecting an average blood sugar level over the past 2-3 months. To improve control, the plan of care should be comprehensive. Increasing the frequency of self-monitoring of blood glucose helps track changes in blood sugar levels. Discussing dietary changes to reduce carbohydrate intake can aid in better blood sugar management. Reviewing the client’s insulin administration technique ensures proper medication dosing. Therefore, all the options (increasing monitoring, discussing dietary changes, and reviewing insulin administration) are essential components of the plan of care to address the client's poor blood glucose control. The correct answer is D because all these interventions are crucial for managing the client's condition effectively. Choices A, B, and C individually address different aspects of diabetes management and are all necessary in this scenario.
2. Amniocentesis, a prenatal diagnostic test used to determine fetal sex, genetic anomalies, and biochemical abnormalities, is based on:
- A. The karyotyping of the amniotic fluid
- B. Chorionic villus sampling
- C. Umbilical cord blood sampling
- D. Ultrasound
Correct answer: A
Rationale: The correct answer is A. Amniocentesis involves the analysis of the fetal cells present in the amniotic fluid, which is extracted from the amniotic sac surrounding the developing fetus. This fluid contains cells shed by the fetus, which can be cultured and analyzed to obtain a karyotype, providing information about the fetal sex, genetic anomalies, and biochemical abnormalities. Choices B, C, and D are incorrect because chorionic villus sampling involves obtaining a sample of the chorionic villi from the placenta, not the amniotic fluid; umbilical cord blood sampling is typically used for other purposes like assessing the baby's blood for infections or genetic disorders; and ultrasound is a diagnostic imaging technique that does not involve the analysis of fetal cells for genetic information.
3. In a client with chronic kidney disease having a serum potassium level of 6.5 mEq/L, which assessment is the most critical for the nurse to perform?
- A. Neurological status
- B. Cardiac status
- C. Respiratory status
- D. Gastrointestinal status
Correct answer: B
Rationale: Corrected Rationale: Assessing cardiac status is crucial in hyperkalemia as high potassium levels can result in life-threatening arrhythmias. Monitoring the heart rhythm and ECG findings is essential to prevent cardiac complications. Neurological status, respiratory status, and gastrointestinal status are important assessments too, but in the context of hyperkalemia, cardiac status takes precedence due to the immediate risk of cardiac arrhythmias.
4. In the critical care unit, which client should receive the most care hours by a registered nurse (RN)?
- A. A client with a newly inserted Foley catheter and Alzheimer's disease
- B. A 55-year-old with chronic kidney disease
- C. An 82-year-old client with a newly fractured femur and soft wrist restraints
- D. A 72-year-old with pneumonia and sepsis on antibiotics
Correct answer: C
Rationale: The client with a newly fractured femur and soft wrist restraints should receive the most care hours as they have physical limitations due to the fracture and mental limitations due to being restrained. This client requires continuous monitoring, support, and frequent assessments to prevent complications. Choices A, B, and D do not have the same level of physical and mental care needs as the client with the newly fractured femur and soft wrist restraints.
5. In a patient with cirrhosis, which of the following lab results is most concerning?
- A. Elevated liver enzymes.
- B. Low albumin levels.
- C. Elevated bilirubin levels.
- D. Low platelet count.
Correct answer: D
Rationale: In a patient with cirrhosis, a low platelet count is the most concerning lab result. Thrombocytopenia, or low platelet count, is common in cirrhosis due to impaired platelet production in the liver. It significantly increases the risk of bleeding and can lead to serious complications such as hemorrhage. Elevated liver enzymes (Choice A) are expected in cirrhosis but may not directly indicate the severity of the disease. Low albumin levels (Choice B) are common in cirrhosis and can contribute to fluid retention but do not pose an immediate risk of bleeding. Elevated bilirubin levels (Choice C) are also expected in cirrhosis and typically indicate impaired liver function but do not directly increase the risk of bleeding as much as a low platelet count.